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ACL Reconstruction and rehab venting (day 1)

 Poster: A snowHead
Poster: A snowHead
Hi! New on the forum, and before I say anything else, I'd just like to say thank you to all you guys contributing here and in ACL-related threads. As a skier with a recent ACL injury, reading your thoughts and experiences has been very helpful and a resource unlike all others I've come across. I find this forum extremely valuable. Thank you.

So... my story. I was an avid skier during my childhood and early teens, with Jon Olsson as my big hero (being Swedish, I guess that's quite predictable). As I grew older, there just wasn't much time left for skiing, until this winter. My fiancée's family has a cabin in the northern parts of Sweden, close to many inviting slopes. We're both working from home, both feeling it'd probably be better (pandemic wise) to isolate in the cabin and having the possibility of still leading a somewhat active life outdoors, rather than dealing with apartment life in Stockholm. So, after ~15 years I found myself standing on a pair of skis again. It was wonderful. I hadn't realised how much I'd missed it. Bought some really good gear (the kind of things I could only dream of in my teens), and started skiing a lot. Rusty at first, but gaining confidence rapidly. After a week or so, I was more or less back to my old standards, yet much more cowardly. After a month, the cowardice was replaced by eagerness to, well, eat snow. Then, realising the season was nearing its end, we booked a ski trip to a new area, further north, taller mountains and hopefully more snow. This would be our last week skiing for the year. The house we rented was beautiful, the slopes full of potential and fun, but... it didn't snow. Spent the first five days mostly avoiding the pistes going through the woods trying to find soft untouched patches with varying success, just hoping for some snowfall. And it came. Day six. Heaps of powder. We went to a new area supposed to offer some of the best off piste in Sweden. Took the lift up, and both me and my fiancé started laughing with sheer joy as soon as we started descending. We tried to get to some untouched parts as far away from the other enthusiasts as possible, and after a few minutes of crossing through trees, we found it. My cowardice turned to eagerness had now turned to unbridled enthusiasm. I almost threw myself out into what I'd later learn was one of Sweden's steepest slopes, with not the faintest clue that hiding under the the powder there'd be ice hard natural moguls. Had the most fun of the season for about 40 metres, and then... mogul... fall... bindings didn't release. Immense pain. Couldn't stand up. Yadayada, completely torn ACL, injuries to my lateral meniscus, hairline fractures in my femur and tibia. No fun. But at least, I got to enjoy a winter full of skiing, and I can't wait to get back out there (though I often wonder to what extent I'll be able to).

This was April 2nd. I've done so much research since then (thank you again) reading anything and everything I could come across, contacted experts, hoped (perhaps naively) that repair could maybe be an option (before I had my MRI). Now, yesterday I had my reconstruction (hamstring graft), and I was surprised as to how good it felt right away.

But today. Today, my first "real" day of rehab is easily the worst day yet. Worse than the day of injury. Everything hurts. My ROM which yesterday felt awesome is gone. Extension feels almost impossible and it frightens me. Flexion brings instant tears to my eyes.

I'm using an ice wrap with compression, I'm taking my prescribed codeine. I'm trying to do my exercises best I can, feeling really bad trying, and terrified of the potential outcome of not succeeding with them. (Who knew straightening a leg could be THIS hard?!). How crucial is it to be able to extend fully more or less at once?

And I've bought all the gear. A kneehab xp which I badly want to use, but I guess I'll have to wait until my band-aids aren't in the way. Floor sliders, a swiss exercise ball, rented a wattbike (still waiting for its arrival), balance pad, foam roller, some posture thing, resistance bands, ankle weights, supplements, the triple stick strap, a vibration plate. the miracle ball method. etc etc... I'm doing everything I can to give myself the best possible conditions for a successful rehab. But right now (and I know it's too early to say anything and that I'm wrong) I feel like I won't ever be able to use any of it. Sorry for all the words. Hadn't planned on posting anything, but right now, I just need to vent. Feel free to delete this topic or move it or whatever. And thank you for your time.

Also! If there's anything you think I could/should add to my shopping list, or well... anything you feel I should hear, I'd very much appreciate it all. Thank you.

(And to end on a funnier note! Some reasons why I started crying my eyes out when the anaesthetics were toying with my emotions on my way home from surgery Embarassed : We had to make a left turn, I remembered that I can't speak German, I didn't know what I wanted to eat AND I realised that I wanted to eat mashed potatoes. My fiancée was both concerned and amused Very Happy )


Last edited by Poster: A snowHead on Wed 21-04-21 11:57; edited 1 time in total
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Didn't realise I posted SOOO many words. Sorry for the rambling and comparative lack of substance.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
@ACLephant, Hi good luck with the rehab. Be very careful in the next 6 weeks to do exactly what you are told by your physiotherapist. Your new ACL is quite vulnerable during this period. It's also quite boring during this stage so be patient.
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My ex partner had exactly the same injuries as you some 2 years ago ..the consultant did not recommend surgery and just gentle exercise with the physio...she is walking ok now and skied last year but used a really good brace (https://www.betterbraces.co.uk/donjoy-armor-knee-brace-with-fourcepoint-hinge) She was a aggressive skier but was a bit more cautious last year
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Not sure if your expectations have been managed on rehab but it's a long and slow road. I was on crutches for a week after the operation.

Proper extension is important but you've probably got a lot of swelling and other stuff going on so don't beat yourself up too much at this stage. I wouldn't buy any more kit unless your physio tells you to. The first few weeks are about getting your ROM back and proprioception

I did my ACL about 17 years ago (!) - skied (very carefully) about 4 months post-op. Wouldn't really recommend that but it was good to feel like I would be able to ski again. Probably ski better now than I did before the operation. Knee does get sore but ibuprofen usually sorts it. I also need to keep it in shape year round - so I ride a bike, which I like almost as much as skiing now, so not really such a bad thing

Good luck!
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Sorry to hear about your injury but rest assured you will be back. I did mine playing rugby in my early 20s and started skiing around the age of 30 and fell in love with it. From what I recall the rehab can be very up and down (physically and emotionally) but you need to push when you can and make sure to ease off when the body tells you too. My surgeon (I also had the hamstring graft) expected me to be back running after 6 months and I did spend a couple of weeks on crutches. The key thing is to be patient and not to expect miracles. Make sure you do the rehab to strengthen the supporting muscles and invest in a balance board (I still occasionally use mine after all these years). My knee has held up to all sorts of skiing, squash and rugby over the past ten or so years and the worst I get is a bit of aching after a long day (first to last lift).
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Thank you for your replies! Yesterday was awful (I barely got any sleep, the pain was unbearable, and everything felt impossible) but today is already better.

I know that rehab will be a long and slow road, and I'm not expecting anything else. I think a lot of it was the psychological shock of really not being able to do the "simplest" things. Not finding the right muscles, barely accomplishing anything despite all possible focus and effort.

It feels great hearing about your recoveries and successes. Thank you – I'm determined to get there, and won't be rushing anything – quite the opposite.

After a night of somewhat decent sleep things feel better overall. I'm not anywhere near able to do the exercises I'm supposed to be doing (at least not as much as I've been told to) but at least I've activated the knee a little, and I hope to do more later today. Extension actually feels ok... at least it feels "possible". Flexion is a different story, but I'll keep trying. Calmly, without fear of discomfort but attentiveness towards pain.

Thank you again.

More important than being able to ski "as usual" next season (at this point, I only feel that'd be a real bummer, but I'd prefer two years of rehab and actual confidence when returning rather than returning too soon) is that I'm supposed to be walking down the aisle and get married in about nine months. I don't want to limp toooo much. But all will be well. Thank you!
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After all it is free Go on u know u want to!
I would add to your shopping list a Cryocuff... simple to use and really, really helps with swelling. Use after EVERY set of exercises to reduce inflammation and your recovery will be shortened.
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@ACLephant, it's feckin tough the first couple of weeks post op.

I was just looking back at the blog I wrote way back in 2012.

Well two weeks now post operation. Must admit to feeling a bit sorry for myself a times thinking is it all worth it as I lie awake at night with my knee feeling uncomfortable, and thinking how people have commented "Jeees Gav you've aged" or "You look really tired" as I fight the frustration of my current situation. But then I put a reality check in place and think how stupid I'm being as there are people far worse off than I!

I'm how hobbling round the house without crutches, this time last week had some really intense pain around the bottom of my shin and nearly took myself to the Doctor, but after some Googling found out that it was fluids and blood from the swelling that had run down (via gravity) into the bottom of my leg, damn painful when standing up, getting out of bed. So been more of the same using the Cyro Cuff three times a day to reduce the swelling, and doing some light exercises to increase ROM (range of movement).


And as @skimottaret, says get a Cryocuff.
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@ACLephant, good luck! Like others on here, have had both ACL’s reconstructed and skied 6-9 months later. Was careful to start with but you quickly get back confidence in the knee and are soon skiing like before. Do be careful in first few weeks though - the temptation to get out quickly is strong but be careful not to aggravate your knee.
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I also had ACL reconstruction in nov 2019, with hamstring graft. What helped me the most with range of motion was stationary bike that I used in the gym. That helped the fluid from the swelling in the knee to move and therefore increase the range of motion. But the first time you use the bike you might not be able to let the leg go the full cycle on the pedal. Somehow it was easier to cycle backwards, when the ROM was at its worst. But 4-6 weeks from the operation cycling was no problem and the most fun sport that I could do.

Regarding leg extension I had to take multiple 20 minute sessions where I sat on the floor, with the heel on top of thick book and 2 kg ankleband/dumbell on the knee. It took me 3-4 months to get full the leg extension correct. I think part of the problem why it took so long time to get the leg extension correct is that I work in office and sit all days. I think it will help if you can stand more in the work. But I got me a big box under my desk so I could sit with the leg straight out and that helped a lot. But still after sitting 2 hours, I was often so stiff that I had to do some stretches to be able to walk not like 90 year old. Afterwards I think I should have taken more of my vacation (PTO) to get out of work and just do rehab. E.g. 1 week every month or something like that. Covid19 closure of the gym was not good either.

One thing that my PT told me was that few years ago the rule of thumb was that people could return back to most sports after 9-12 months. But they have changed it to 14 months, because it was too early too often. Of course different from pro athletes. So because of that I decided not to touch my skis until next winter and dirtbike until this spring. Also I read somewhere that the new ACL takes 2 years to grow full strength. Don't know if that is true or not.

The worst exercise in the first few weeks that I was supposed to do (according to surgeons office) was laying leg curl (no weight). Because of the hamstring graft that was rather sore. But my PT told me to wait with it, it would only give me pain for the first weeks.

The progress in the rehab comes in small steps. I knew this would take time, but I wanted to see progress every two weeks, but somehow the progress was more noticeable every second month.
But there is nothing else to do than keep on going.
Good luck.
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
The hamstring graft we terrible for the first few weeks for me - I think it was just the scarring but every now and then something would tear and it felt like my whole hamstring had torn Crying or Very sad It's fine now though
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Arno wrote:
The hamstring graft we terrible for the first few weeks for me - I think it was just the scarring but every now and then something would tear and it felt like my whole hamstring had torn Crying or Very sad It's fine now though


That can be pretty alarming. But to reassure those who have been offered a hamstring graft- it is easy to get minor tears in the hamstring bed for upto 8 weeks. Be careful not to rapidly stretch the hamstring in that period. Typical ways you can inadvertently pull it are; sitting in bed with legs straight an you lean forwards towards the feet( bend the knee to avoid), picking something up from the floor with out bending the knees, letting the leg drop straight when doing your early hamstring curls.
It is painful , settles in 24-48 hrs and rarely has any long term consequences.
Jonathan Bell
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 You know it makes sense.
You know it makes sense.
@Jonathan Bell, one time I tweaked it on an escalator coming out of a tube station during my commute. The howl of pain actually got some commuters to look up from their copies of Metro Laughing
I had been warned in advance that it might happen so it wasn’t particularly worrying just painful
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
@Arno, have you had any instances of a pulled hamstring(s) since your operation?

I've torn / pulled mine probably two/three times since which makes me wonder if losing a hamstring for the graft weakens them or it's just another factor of increasing years and continued abuse?
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 Poster: A snowHead
Poster: A snowHead
Good luck with the rehab!

I'm no expert but I think that, while we should try as much as possible to stick to the recommended exercises, in practice various people recover at various rates, which actually change during the rehab process.

I remember that my first days were really bad, then the next period until two months I was doing great, well above expectations, and then I had a regression and for a month I was behind again.

So it will ebb and flow, be prepared for it... have patience, keep trying.

FYI: like Arno, I also skied 4 months after the OP (VERY carefully, with a brace, and with my surgeon's blessing). Generally skiing before 6 months is not recommended. However I then skied properly 9 months after the operation and my knee was still hurting quite a lot, especially later in the day and in the week.

Then again, the knee pain may have had something to do with doing this type of stuff:
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Thank you so much for your words, thoughts, and time. Now, a day shy of two weeks post-op, everything feels so much better. Those first few days were a bit overwhelming.

My pain is more or less gone, I can extend fully, bend enough to comfortably bike, walk slowly and carefully with correct gait, and I am much more positive overall. The only "big" remaining issue is getting enough sleep, as constant pressure from the mattress on any part of my knee has me wanting to shift positions every ten minutes. But for a "big" issue, it's really nothing. I take whatever sleep I get.

Having seen my physiotherapist a couple of times now, she seems quite impressed with my progress, which also is very uplifting. And I attribute a lot to the big rehab club thread on here, and all your tips. The kneehab xp has been great, helping me activate muscles I initially found it hard to control unaided. Floor sliders really do remove unnecessary strain from many exercises. The wattbike's direct feedback on how much I'm using each leg has been an eye opener, etc. So thank you!

My mission for the coming days is to get my calfs functioning better. They're... they're very weak compared to the good leg. That, and to be more useful around the house. My poor fiancée has had to deal with a lot, while I'm icing or resting or too tired, or simply not able to... But one day at a time... All will be well.

Seeing you guys ski again, and reading your stories really is wonderful – I can't thank you enough.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
@ACLephant, a pillow between your legs can really help with sleep, this one helped me massively and doesn't come loose when you shift about

https://www.physioroom.com/product/PhysioRoom_Memory_Foam_Leg_Pillow/3577/42640.html?gclid=Cj0KCQjwvr6EBhDOARIsAPpqUPFifKvf6lGe-PytAx4xugqClFfzMhZFRsnRUlLv4Ca0UaI0Qc1Ta04aAtUuEALw_wcB
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Someone posted a very interesting video of a meniscus trim on one of the ACL threads recently. Can’t seem to find it. Any ideas?
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Think it was me when he found I had no ACL


http://youtube.com/v/Km3iF8wOCQk
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Hi,
I have been Skiing for the last 5 seasons, which I love.
I have a query, which I hope someone can help me with. I have a weak knee from playing soccer years ago. I find that by day 4 of skiing I am beginning to struggle (slight swelling and stiffness), not enough to prevent me skiing but a bit uncomfortable. I was wondering if Snowboarding is any easier than Skiing on the knee joints?? I am 49, a reasonable skier, fairly fit, not carrying much weight.
Thanks,
CJ.
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Maybe another thread would be best for that: you may find one already.

Whilst I'm here... I'm fairly sure that snowboarding does less damage, based on riding with numerous people who spend a lot of time on one or the other.
In my direct experience most skiers who can afford a helicopter are of a certain age, and they've nearly all benefitted from some knee surgery.
I've not noticed that with snowboarders, and not had any work there myself.

It's quicker to become competent in a second snow sliding sport once you have the first down,
but it's still not the work of one afternoon and requires some commitment. Decide how many weeks
you're going to invest and then you'll be fine. Just muck about a bit, and you'll feel like a beginner and quit.
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